Elevated blood lead levels associated with retained bullet fragments — United States, 2003–2012

What is already known about this topic? Gunshot wounds cause an estimated 115,000 injuries in the United States per year, approximately 70% of which are nonfatal. Bullet removal is not routinely indicated for victims of gunshot injuries with retained bullet fragments (RBFs) unless they are a cause of immediate morbidity. Symptoms of lead toxicity are often nonspecific and can appear years after the initial injury. States participating in the Adult Blood Lead Epidemiology and Surveillance (ABLES) program require health care providers and laboratories to report blood lead level (BLL) test results to the state health department. The primary focus of adult screening is to detect occupational exposure; RBFs are a less recognized potential source of lead exposure. What is added by this report? During 2003–2012, ABLES programs in 41 states reported 145,811 persons with BLLs ≥10 µg/dL. RBF-associated cases accounted for 457 (0.3%) of 145,811 persons with elevated BLLs. Among 349 persons with BLLs ≥80 µg/dL, 17 (4.9%) were RBF-associated; the maximum recorded RBF-associated BLL was 306 µg/dL. Elevated BLLs attributable to RBFs occurred primarily among males aged 16–24 years, whereas the greatest number of non-RBF–associated cases occurred among persons aged 35–44 years. What are the implications for public health practice? Persons with elevated BLLs with unknown lead exposure source should be asked about RBFs. Furthermore, baseline and intermittent BLL tests should be considered in persons with a history of RBFs.